Valley Fitness Registration Form

Welcome to Valley Fitness. Please complete the registration form to participate in our classes.

First Name *

Date of Birth *

Last Name *

Gender

Mobile Number *

Email Address *

Has Medical Notes *

Yes

Medical Notes

Home Address *

Home City *

Home State *

Home Postcode *

Photography and Videos

Photography *

Allowed

Internal Use Not Allowed

External Use Not Allowed

Accident/Injury

Accident / Injury *

In the event of accident or injury, I give permission for suitably trained leaders to administer first aid if required. I further authorise the use of ambulance and/or anaesthetic by a qualified medical practitioner if in his/her judgment it is necessary. I accept responsibility for payment of all expenses associated with such treatment.

Emergency Contact Details

Emergency Contact name and number

Participation Disclaimer

This document is a release of claims. It is a pre-requisite to participation in Valley Fitness classes. By signing it you acknowledge the following:

- I willingly participate in Valley Fitness at my own Risk.

- I have no known physical restrictions, disabilities or any pre-dispositions to sickness or injury that may be aggravated or adversely affected as a result of taking part in exercise (*unless written consent is given by your GP in light of the increased risk posed by your disability or sickness).

- I agree that any information, instruction or advice obtained from Valley Fitness trainers may not be used as a substitute for my doctors advice or treatment.

- I take full responsibility for any injury, loss or damage to you that may arise directly or indirectly from my participation in exercise.

- I agree to discharge Narara Valley Baptist Church from any and all responsibilities or liabilities from injury arising directly or indirectly from my participation in Valley Fitness.

- I agree to indemnify and hold harmless the Baptist Union of NSW, the church and any individual staff or voluntary leaders against all claims arising out of any injury to the child and the relevant activity being undertaken unless such injury results from a failure in the duty of care of the Baptist Union of NSW, the church or any individual staff or voluntary leaders.

By marking this box I declare all information provided is accurate and up to date, and I reaffirm all permissions granted.

Agreement to Disclaimer *

Yes, I Agree

Full Name *

Relationship to Child (If Completing for a person under the age of 18)

Date of Declaration *